From the Departments of Medicine and the Divisions of Pulmonary and Critical Care Medicine (Drs. Moss and Guidot, Ms. Duhon), Emory University School of Medicine, Atlanta, GA; the University of Colorado Health Sciences Center (Mr. Wolken, Dr. Parsons), Denver, CO; the University of Washington (Dr. Steinberg, Ms. Treece, Dr. Hudson), Seattle, WA; and the Carlyle Fraser Heart Center, Atlanta, GA (Dr. Moss).

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Abstract

ObjectiveOur ability to predict which critically ill patients will develop acute respiratory distress syndrome (ARDS) is imprecise. Based on the effects of diabetes mellitus on the inflammatory cascade, we hypothesized that a history of diabetes might alter the incidence of ARDS.DesignA prospective multicenter study.SettingIntensive care units at four university medical centers.PatientsOne hundred thirteen consecutive patients with septic shock.InterventionsNone.Measurements and Main ResultsAll patients were prospectively followed during their intensive care course for the development of ARDS. A history of diabetes was identified in 28% (32/113) of the patients. In this study, nondiabetics were more likely to develop septic shock from a pulmonary source (48%, 39/81) compared with diabetics (25%, 8/32) (p = .02). Forty-one percent (46/113) of the patients with septic shock developed ARDS. Forty-seven percent of the nondiabetic patients developed ARDS compared with only 25% of those with diabetes (p = .03, relative risk = 0.53, 95% confidence interval = 0.28–0.98). In a multivariate logistic regression analysis, when we adjusted for several variables including source of infection, the effect of diabetes on the incidence of ARDS remained significant (p = .03, odds ratio = 0.33, 95% confidence interval = 0.12–0.90).ConclusionsIn patients with septic shock, a history of diabetes is associated with a lower risk of developing ARDS compared with nondiabetics.